Notes for Final Chapter 6/11- Anaphylaxis Allergic reaction Acute Sx: hives, rash, itching and nasal secretions, fever, malaise Severe: hypotension, tachycardia, bronchoconstriction Tx: Benadryl, put vaccine in dominant arm, warm compresses, Tylenol Chapter 8- Pain NSAIDS -ASA, Ibuprofen (motrin), Ketorolac (Toradol), Naproxen (Naprosyn) Mild to moderate pain Take with full glass of water Do not mix ASA with other NSAIDS Monitor for GI bleeding Opioids –Codeine, Hydrocodone, -Morphine, Darvocet Moderate to severe pain Monitor for respiratory depression, urinary retention, constipation Naloxone to treat respiratory depression
Chapter 10- Surgery –Laparoscopy- Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs . Laparoscopy is used to find problems such as cysts, adhesions, fibroids , and infection. Tissue samples can be taken for biopsy through the tube (laparoscope) –Pre op meds- –Urogential- is the organ system of the reproductive organs and the urinary system. These are grouped together because of their proximity to each other, their common embryological origin and the use of common pathways, like the male urethra. Radial mastectomy- removal of the entire effect breast, underlying chest muscles, and lymph nodes under the arms. (modified is when the chest muscles are intact. ) Chapter 12- Cancer –Tumor Markers proteins produced/secreted by malignant cells found in the blood CA 125- cancer protein PSA- prostate specific antigen ACTH- andrenocorticoptropic hormone hCG- pregnancy –Diagnostic Tests Xray- cannot distinguish between xray and cysts and tumors CT scan- Renal, gastro and lymph node cancers. Check for allergy to shellfish Ultrasound- Uses sound waves. Best in breast and prostate. MRI- Uses radiofrequency. Best in head and neck tumors.
Angiography- Tumor location is unknown. Page 1 Chapter 13- Death & Dying –Kubler-Ross Denial, Anger, Bargaining, Depression, Acceptance –Advance Directives- legal document that specifies healthcare and financial affairs in case of incapcity –Living will -determines wishes in case of terminal illness or unconsciousness –Postmortem Care- Raise head of bed 30 degrees to prevent pooling –Hindu- Take loved ones home to die. Family and friends will keep a vigil until the moment of passing by singing, praying and reading scriptures. The mantra is chanted and holy ash is placed on the forehead, and holy water or milk is dripped into the mouth. ever embalmed, and the organs are never removed for donation. Chapter 14- Shock –Lots of questions on shock. Please review carefully. Page 316. –Know types, symptoms, treatment for each) Chapter 16/17- Cardiovascular –Central Venous Pressure- CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. IN the thoracic vena cava. –Normal range is 3-8 mmHg –Inderal (propanolol)- treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, tremors, and lowers the risk of repeated heart attacks. Its a beta blocker. –
Chapter 18- Peripheral Vascular Disorders -Hypertension- BP 140/90. -Hypertensive Crisis- 180/120 -DASH diet- 2,000 calories. 7-8 grains, fewer than 2 servings of protein •Review pages 430- 438 Chapter 29- Urinary System –Urinary Tract Infection- #1 Noscomial infection Most common location is the bladder (cystitis) Most common upper UTI is kidney and renal pelvis (pyelonephritis) Most common bacteria to cause UTI is e-coli –Difference between Cystitis and Pyelonephritis Cystis- Dysuria, urgency, nocturia, Pyuria, Hematuria Pyelonephritis- Same as above plus flank pain, N-V-D, fever, malaise –Urinary Calculi.
Stones made from Ca. Dull, aching to severe flank pain. Nausea, vomitting. Gross hematuria. –Lithotripsy- crushing stones through sound waves –Acute Renal Failure. -Rapid onset. Reversible. Most common cause is ishemia (poor perfusion to the kidney) Most common symptom is oliguria (urine output less than 400 mL/day) High BUN and creatinine levels Page 2 Occurs in 3 stages: initiation (up to days), maintenance phase (up to 2 weeks) and this is where all the problems occur, and the recovery phase (up to 1 year) – Glomerulonephritis Leading cause of kidney disease and failure Caused by strep (a beta-hemolytic strep)
Surrounded by bowmans capsule Sx: hematuria, proteinuria, hypoalbuminemia, azotemia (increase Nitrogen) Lasts 10-14 days –Nephrosis- nephrosis is any degenerative disease of the renal tubules. Nephrosis can be caused by kidney disease, or it may be secondary to another disorder. It should not be confused with nephritis, where inflammation is implied. –Nephrotic Syndrome Same as above but there is a significant loss of protein lost in urine Found in lupus and those with kidney disorders Sx: proteinuria, low albumin, high lipids, and severe edema in face and periorbital area. Blood clots are common. –Urine Dipstick H 6-6. 5 Specific gravity 1. 010-1. 025 Everything else is negative in a healthy patient –Potassium Normal 3. 5-5. 2 –Sodium Normal 135-145 Drugs that lower sodium levels are diuretics, (epi-/ norepi), decongestants and antidiabetic medications IV solutions that increase sodium are NaCL Chapter 31- Male Reproductive – Transurethral resection of the prostate (TURP) – is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision. Inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time.
The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure. TURP is generally done to relieve symptoms due to prostate enlargement, often due to BPH. BPH is a condition in which the prostate gland may become quite enlarged and cause problems with urination. Symptoms may include Problems with getting a urine stream started . Nocturia, urgency, dribbling. Monitor for hemorrhage for the first 24-48 hours. Chapter 32- Female Reproductive –Metrorrhagia Bleeding between periods Sign of cervical or uterine cancer –Dilation and Curettage (D &C) Page 3 –Cervical canal is scraped
Monitor for circulation. Avoid pillow under legs. Avoid tampons for 2 weeks. –Vaginitis Fungal (candidiasis) Protozoan (trich. ) bacteria (granderella) Chapter 34/35- Endocrine System –Biofeedback Mechanisms (3 below) 1) glucose maintenance- interplay between insulin and glucagon, pancreatic hormones that release glucose and store glucose, respectively 2) body temperature maintenance -hypothalamus, nerves, skin, sweat glands, heart(beats faster if warm), kidneys -if your temp. increases due to exercise/warm weather/illness: sweating occurs to produce evaporation which leads to cooling -if your temp. ecreases due to cold weather/being scared/illness: “goose bumps” (piloerection) occurs, which are thought to be derived from a response that enable the hair to stand on end causing more insulation and heat 3) fluid maintenance- -kidneys regulate how much fluid is excreted. If you are dehydrated they will produce less urine. If you drink a lot of fluid quickly, then more urine will be excreted –Thyroid sits on either side of trachea Isthmus connects two lobes Needs iodine to secrete t4 (thryoxine) and t3 (triiodonthronine) that increases metabolism Also secretes calcitonin that decreases excess calcium levels in the blood –Hyperthyroidism
Too much thyroid hormone SS: Increased appetite, yet loses weight. If left untreated, will cause cardiac dysrhythmias and heart failure Develops into 2 disorders: Graves disease and thyroid crisis Graves disease (goiter & exophthalmus- protruding eyes) –Exophthalmus- protruding eyes –Thyroid storm- High fever (>102), tachycardia, hypertension, restlessness, seizures, delirium –Thyroidectomy- Will be on lifelong replacement hormones Euthryroid state (balanced hormonal state before surgery) Nursing precautions: hemorrhage, respiratory distress, laryngeal nerve damage, tetany, thyroid storm Myxedema- form of hypothyroidism Brought on by exposure to cold, infx, temp, trauma, narcotics & tranquilizers More frequent in women SS: seizures, lethary to coma, hypothermia. Respiratory and cardiovascular systems shut down. Tx: airway, Cardiac function, increasing Temperature and TH levels by getting levothyroxine by IV. Page 4 –Cushings Syndrome Adrenal cortex produces too much cortisol (hormone) or ACTH SS: fat deposits in abdomen, clavicle, buffalo hump, round moon face, hirsutism (excessive facial hair) Dx: Increase cortisol level and elevate 24 hour urine test with 17- ketosteriods and 17- hyroxycortcosteriods.
Low potassium, Sodium and glucose levels are also higher. Meds: lysodren and cytadren are commonly used. –Addisons Disease Adrenal insufficiency SS: decrease glucocoritcoids, mineralcorticoids, and androgens Tx: IV fliuids, glucose, Na, glucocorticoids, warm and quiet enviroment Dx: Decreased levels of cortisol, decreased 24 hour urine test with 17- ketosteriods, Potassium is increased, glucose and sodium are decreased. –Pheochromocytoma benign tumor of adrenal medulla Produces excessives amounts of epinephrine and norepinephrine Stimulates the sympathetic nervous system
SS: BP 200-300/150 +, pounding HA, profuse sweating, tachycardia, flushing, Dx: increased catecholamine levels in the blood or urine, CT scan. Adrenaelectomy Nursing care: stabilize BP –Adrenalectomy Removal of adrenal gland High risk of Addisonian crisis or adrenal crisis. – Addisonian Crisis hypotension, rapid weak pulse, extreme weakness, confusion, circulating collapse and shock. Dangerously low K+ levels. – Diabetes Insipidus Results from lack of ADH hormone Two types: neurogenic (damage to pituitary) and nephrogenic (Kidneys) Risk for hypernatremia Sx: Polydipsia, polyuria (5-15 ml. day) urine specific gravity of less than 1. 005, very pale urine, weakeness, dehydration, tachycardia, poor skin turgor, dry mucous membranes Nursing Care: managing fluid and electrolytes, replacing ADH. Monitor daily weight. Meds: Vasopressin (monitor for h/a and abdominal cramps). Thiazide diuretics and low sodium diet Chapter 36- Diabetes – Normal blood glucose is 70-100. –Diagnosing Diabetes plasma glucose level (>200) oral glucose tolerance test (2 hour test, >200) fasting blood glucose (8 hour test, > 126) –Peripheral Vascular Disease Greater in Type 2 Atherosclerosis of lower legs Page 5
Leads to gangrene. (Most common cause of amputations) SS: hair loss, atrophic skin, cool feet, red- white legs, thick toenails, pain with walking aand at rest (usually at night), diminished or absent peripheral pulses. – Type 1 Diabetes Destruction of beta cells leads to state of absolute insulin deficiency Usually occurs in childhood Prone to developing ketoacidosis Insulin dependent Sx: Polyuria, polydipsia, polyphagia, weight loss, fatigue, malaise, blurred vision –Type 2 Diabetes Sufficient insulin to prevent ketoacidosis, but to lower blood glucose Usually occurs after 30 Most clients are obese
Insulin requiring but not dependent Sx: Polyuria, polydipsia, obesity, recurrent infx, fatigue, blurred vision, parenthesias (numbness and tingling around mouth and hands and feet. ) – ADA 1800 calorie Diet –Diabetic Acidosis Occurs in Type 1 diabetes Sx: hyperglycemia, dehydration, coma, BS > 250, ketonuria. Metabolic Ketoacidosis= fruity, alcohol breath Common in those who are undiagnosed. Tx: fluids, insulin, correction of electrolytes. Unconsciousness patients need 0. 9% normal saline to replace sodium. Start with 0. 9, then 0. 45%. Dextrose is added to prevent hypoglycemia. –Exercise
Reduces blood glucose by increase glucose use by the muscles. Eat snack before exercising. Avoid exercising if fasting is > 250. –Only regular insulin may be given b y the IV route. –HHS (Hypersmolar Hyperglycemic State) Occurs in Type 2 Characterized by severely high glucose (600 or >), extreme dehydration, and altered LOC, grand mal seizures. –Differences between DKA and HHS DKAHHS Type 1Type 2 Lethary Coma Kussmauls breathsRapid, shallow breathing Glucose >250Glucose > 600 *Kussmauls breathing – rapid, deep respiration to prevent decrease in pH. –Somogyi Effect Morning rise in glucose after a nighttime hypoglycemia.
Sx: temors, night sweats, and restlessness. Tx: Eat bedtime snack –Dawn phenomenon Rise in glucose between 4 am and 8 am. Tx: increase insulin dose or changing injection time from dinnertime to bedtime Page 6 –Hyperglycemia Sx: Increased thirst and frequency Diet: low carbohydrates and sugar, sufficient hydration, and frequent small meals. –Hypoglycemia Sx: carry an emergency snack high in carbohydrates to help raise low blood sugar. People who have experienced hypoglycemia in the past should eat meals at regular intervals, avoid excessive alcohol and never drink alcohol on an empty stomach.
Chapter 37- Nervous system – Cerebrovascular Accident- Brain attack or stroke Thrombotic CVA- Caused by atherosclerosis of arteries. Happens during or after sleep. Embolic CVA- caused by problems with the heart Hemorrhagic CVA- caused by hypertension Right Side vs Left side Effects left sideEffects right side VisualSpeech (Left-Language) UnawareAware ImpulsiveSlow, cautious –Heat stroke heat cramps, heat syncope (fainting), and heat exhaustion . nausea, seizures, confusion, disorientation, and sometimes loss of consciousness. Remove any extra clothes. – Frost bite Dont put direct heat on it.
Wrap in blankets or move to a warmer environment. Chapter 38- Intracranial Disorders –Closed head injuries Coup-contrecoup- jerking forward-jerking back –Concussion brain injury resulting from violent shaking or impact –Contusion bleeding into soft tissue resulting from blunt force –Epidural Hematoma severe blow to brain causing arterial bleeding between skull and dura mater. –Subdural Hematoma injury between dura mater and subarachnoid layer –Intracerebral Hematoma Bleeding into brain caused by gunshot wound or depressed skull fracture –Simple partial seizure- jerking of finger, hand, foot, leg and face.
Called Jacksonian March. – Sx: flashing lights, tingling sensations, or hallucinations. –Complex Partial Seizures Sx: lip smacking, aimless walking, picking up clothing –Absence seizures- In children. blank stare. Lasts 5-10 seconds. May be unaware. –Tonic-clonic seizures- Adults and children. From trauma. Stages: aura, tonic phase, clonic phase, postictal phase Up to 30 mins Page 7 Chapter 39- Neurologic and Spinal –Multiple Sclerosis degenerative disease that damages myelin sheath surrounding axons. Marked by periods of exacerbation and remission Effects Women between 20-50
Myelin sheath is the white matter in the CNS Pt is prone to UTIS, pressure ulcers, joint contractures, pneumonia, depression Dx: CSF (cerebrospinal fluid analysis). Look for IgG. , MRI and CT scan. –Parkinson’s Disease Results from a lack of dopamine 3 cardial signs: tremor, rigidity, bradykinesia. Pill-rolling. Levodopa- Used to treat shaking, stiffness, and slow movement Anticholinergic- Med for Parkinson’s –Sx: dry mouth, orthostatic hypotension, constipation, urinary hestation, pupil dilation, blurred vison, dry eyes, photosenstivity, increased heart rate. –Myasthenia Gravis
Marked by periods of exacerbation and remission Sx: eyelid ptosis (drooping eye), diplopia (double vision), slurred speech, nasal voice, difficulty chewing or swallowing Face appears to have a snarl or grimace Risk for aspiration and respiratory insufficiency –Cholinergic Crisis caused by taking meds too early. Sx: Severe muscle weakness, NVD, increased salviation, sweating, bradycardia. –Myasthenic crisis Caused by taking meds late Sx: muscle weakness, inability to speak/swallow, respiratory distress, anxiety –Trigeminal Neuralgia Causes pain along both sides of face.